Elder Abuse Prevention-One Advocate's 25-Year Perspective
Nerenberg, Lisa, Aging Today
Second of two articles
When I first started working in the field of elder abuse prevention nearly 25 years ago, there were few services in place. Since then, communities have shown remarkable ingenuity in responding to a problem as far-ranging as caregiver neglect, violence against intimate partners and exploitation by predators. In doing so, they have appropriated approaches from other disciplines that reflect widely divergent assumptions and goals. Like any field, ours has been shaped by a confluence of events, discoveries and happenstance. Three years ago, when I set out to write a book about abuse prevention, I decided to describe the field through the events, themes and models that shaped and define it. Elder Abuse Prevention: Emerging Trends and Promising Strategies was released earlier this year by Springer Publishing.
When elder abuse first came to light in the late 1970s, states responded by enacting reporting laws patterned after those developed years earlier for child abuse. This approach assumes that elderly victims, like children, are unable or unlikely to seek help on their own. Hence, these statutes enlist service providers and the public to report abuse to public agencies. Most states designated adult protective services (APS) agencies, created in the 1960s to help adults with disabilities who were unable to manage on their own, as the primary responders in cases of elder abuse.
Although the reporting system brought numerous cases to light, it has limitations. Unlike their colleagues in child protective services, who can intervene dramatically to protect children under the principal of parens patria (the state's obligation to protect children whose parents fail to), APS workers assume that adults are competent, so professionals can only offer help. (The two exceptions are when a person is deemed incapacitated or if the abuse is criminal.)
Many victims exercise their right to refuse help because they fear retribution or worry about making matters worse. Others are demoralized or don't want to see their abusers, mostly family members, punished. Frustrated by such clients over the years, we professionals often reminded ourselves that defending elders' autonomy was as important as protecting their safety. Empowerment replaced protection as the goal, and the terms elder rights and elder justice appeared in the elder abuse lexicon.
Still, some of us working in elder abuse suspected that victims' resistance stemmed from the perception that we weren't offering the right kind of help. This skepticism, I believe, accounted for our field's enthusiasm for domestic violence (DV) theory and practice in the early 1990s. DV theory, which emerged from the women's movement, holds that DV stems from the culturally sanctioned belief that men have the right to exert power and control over their intimate partners. Furthermore, it is based on the belief that gender-based discrimination, social and economic inequalities, and tolerance for violence against women contribute to and perpetuate abuse.
Advocates understood the social, economic and cultural barriers that battered women faced and recognized that seeking help was a process. They developed techniques for helping victims work through denial, ambivalence and fear while remaining safe. Drawing from DV practice, the elder abuse network launched support groups and shelters, explored the use of restraining orders and ,safety planning, and encouraged victims to report to police. Many of these interventions, we discovered, could be adapted for male victims, nonintimate partners and victims of financial abuse.
DOMESTIC VIOLENCE LIMITATIONS
But just as the child abuse model had limitations, so too did the DV model. Because DV advocates weren't thrilled by the liberties we took with DV theory, tensions developed between the two networks in some communities. Research also emerged suggesting the need to reconsider certain interventions. …